By: Louise Allyn Palma
When Dr. Catherine Yu, family physician in the East Toronto community, identified that her patient needed a CT scan, she knew she was looking at a three-month wait.
But when her patient circled back with reoccurring symptoms, she had a frightening thought: Brain tumour.
Dr. Yu immediately dialed the number for SCOPE in hopes she would receive some assistance.
The SCOPE (Seamless Care Optimizing Patient Experience) Program prioritizes effective access to hospital and community resources for family physicians. Dr. Ruth Hussman, SCOPE Physician Lead, describes the program as a “good service, which feels like virtual extra help.”
“Physicians are really busy in their offices and are constantly being pulled in different directions. Because of this, they do not have the time to know about all the available resources for their patients or make the referrals,” says Dr. Hussman.
Through SCOPE, family physicians can dial a single phone number which will connect them with the options to different hospitals who host a SCOPE program. In Toronto’s East End, physicians have the option of selecting Michael Garron Hospital (MGH), Toronto East Health Network as a resource to connect with other services and programs in the community.
The single number directs physicians to four choices: general internal medicine specialist, home and community care coordinator, nurse navigator or medical imaging. Depending on the needs of the family physician and their patient – they can decide which service to contact.
Dr. Yu was able to get direct access to Diagnostic Imaging. She explained her concerns, and a CT scan was booked for the following day.
“I think the test was done on a Thursday, and I thought that I would give it a few days until the results were processed. But not only was the scan finished, the patient had already been sent to the emergency room because there was a brain tumour,” she says.
When SCOPE went live at MGH on Feb. 28, Sufyan Khatri took on the role of nurse navigator. As the nurse navigator, Sufyan provides direct support and resources for the family physicians that call in.
He navigates city-wide resources and expedites all kinds of requests, depending on the needs of the physician and patient. Sufyan prompts the physician with a series of questions about the patients, and after retrieving the necessary information – moves forward looking through a series of resources within a database. After contacting those resources, Sufyan connects with the physician again with the available clinics or resources that have the capacity for the patient based on the urgency, location or needs of the patient.
“It’s a personalized service,” Sufyan says.
“We want this service to work for our physicians out in the community. So, we try to help out as much as possible to make SCOPE successful, as it is primarily for the patient and physicians,” he adds. The nurse navigators across the hospitals which host SCOPE meet bi-weekly to discuss their experiences with SCOPE. They all share the common goal to create “smooth service for the physicians,” he says.
Dr. Yu explained the feeling of relief when she learned that her patient had already been booked for neurosurgery, and was receiving the care that she needed.
“By the time I was looking at the notes on Saturday two days later, the patient had already undergone surgery. I expected to be on the phone to get a neurosurgeon, but it was all done without me having to connect the dots. So, I was really happy with the outcome,” she says. “And the patient is doing really well right now.”
The goal of SCOPE is to have physicians using it, thinking of it as another tool to help manage their patients, Dr. Hussman explains.
“It’s time-consuming for family physicians to sort through and research different resources, when they could be dealing with their patients in real time. Having a direct line to link us to certain resources, we are saving ourselves time in the office and helping our patients connect with what will help solve their problem,” she says.
For those family physicians that are part of SCOPE, they also have direct access to a general internal medicine specialist to help them manage more complex cases. After calling SCOPE and giving a few details of the case to the nurse navigator, the specialist will then call them back within 30 minutes and provide advice over the phone. Sometimes this is all that is needed, but in the cases that are more acute or complicated, an urgent appointment can then be made to see the specialist at MGH.
Dr. Christopher Smith is a general internist at MGH and the internal medicine lead for SCOPE. He says, “The goal of this interaction is to provide the family doctor with all the support they need to best care for the challenging cases that are in their office. This may be advice about how to optimize a treatment or about appropriate tests to order to investigate a complicated problem. Other times, it is clear that the patient needs to a specialist and we aim to see them as fast as possible.”
Physicians can go onto the SCOPE website and easily register online to use the SCOPE services. Once they’ve registered, they are e-mailed with the phone number to reach the SCOPE program.
Sufyan expressed the effects of working independently: “MGH is a community-based hospital and the community that inhabits it is vast in culture and people. For our community to be healthy, it only makes sense that the community works closely with the hospital that is serving that community. If we work solo, the patient will experience difficulties. The main aim for SCOPE is to be the bridge between the hospital and the physician.”
“We are serving ourselves by serving the community,” he says.
“SCOPE enables primary care physicians, hospital specialists and hospital leadership to come together to solve the problem around care coordination and accessing the right services at the right time,” says Dr. Nicole Nitti, East Toronto Primary care Lead and Family Physician & Medical Director, Access Alliance Multicultural and Community Services.